Newsletter January 2011

As people age, their bodies become more resistant to insulin because the body’s cells don’t respond to insulin as they did in the past. Though controlling diabetes is challenging, it can become more so as people age. Low blood sugar often is a factor in falls and other safety concerns, because it triggers dizziness, nausea, and weakness. Changes in vision occur, and the level of consciousness can drop. Resultant changes in equilibrium can precipitate falls, and for elderly persons, falls are a major cause of disability.

Blood glucose testing is a help in evaluating what causes falls. Low blood sugar is easily diagnosed with a glucometer. Keeping an emergency kit of glucose handy will decrease the risk of falls and improve safety for seniors with diabetes. Letting the doctor know right away about a fall or a sudden drop in blood sugar is advised.

Monitoring blood sugar can be especially difficult for senior with unsteady hands or vision problems. Seniors with diminished senses of taste and smell also find it increasingly difficult to maintain a healthy meal plan and good nutrition. Older adults don’t recover as quickly from injuries or illness, and fluctuations in blood sugar levels often contribut to mood swings, depression, or irritability. Because stress affects blood glucose level, emotions experienced by an older adult with diabetes could be the result of a sudden drop or increase in blood sugar, caused by metabolic changes and stress chemicals such as cortisol.

Overnight changes in blood sugar levels are normal, but there are some easy tips for preventing major problems. First, limit carbohydrate intake in the evening. Late snacks should include fats and proteins. Next, get some evening exercise to reduce sugars before bedtime. Third, talk with the doctor about adjusting medications. Maybe most important, don’t ever skip meals or medications. Omitting either one can interfere with the body’s systems and exacerbate problems.

WARNING SIGNS:  Does your parent need help?
According to the Mayo Clinic, it’s important to monitor whether your parents are taking good care of themselves and staying healthy and safe. Here are the top five questions to ask yourself as your parent gets older.

1. Has your parent lost weight?
This can be a sign that something’s not right. It’s one thing if Mom or Dad is trying to diet, but unintentional weight loss can be a warning sign. It could indicate that your parent is having trouble cooking, or finding the energy to cook and prepare nutritious meals. It could also be a sign of diminished taste or smell; this is natural as we grow older, but a decline in these senses can result in a diminished interest in eating. Other conditions such as malnutrition, depression, cancer, or dementia can sometimes be recognized early when unexplained weight loss is noticed.

2. Are your parents taking care of themselves?
Pay special attention to your parents’ appearance, including clean clothes, good grooming, or sudden changes in either. If you do not live with your parent, you can check up on this through friends or neighbors, or by persuading Mom or Dad to send you recent photos. A lack of attention to daily personal routines may indicate health problems or physical impairments.
Pay attention also to your parent’s home. Signs of possible trouble include lights that don’t work, neglected yard maintenance, or appliances that need repair. Scorched pots and pans in the kitchen are a sign that Mom or Dad may be having issues in the kitchen. A parent who is neglecting housework or home maintenance could be having problems with depression or other health issues.

3. Are your aging parents safe in their home?
Take a good look around when you visit, or ask a friend or neighbor who visits there to give you a report. Does your mother have trouble negotiating stairs? Has your father fallen recently? Do they have trouble reading labels on medications? Have you heard about any recent visits from strangers? (“He was such a nice young man. He was selling a new home warranty program, and I invited him in for cake and coffee.”)

4. Is your parent in good spirits?
Take note of your parent’s moods and ask how the day went. A sudden different mood or attitude can be a warning sign of depression or other health concerns. Inquire about activities, too — is Mom connecting with friends? Has Dad stopped having morning coffee with his buddies? Has your parent recently given up on previous hobbies or activities? Withdrawal from previous social activity is a red flag for issues you should follow up on.

5. Is your parent having trouble getting around?
Pay attention to how your parent walks. Does your mother hesitate now to walk her usual distance? Does your father have difficulty with his hip or knee that’s making it tough for him to get around? Would a cane or walker help? Joint problems and muscle weakness are a part of aging, but people who are unsteady on their feet are at increased risk of falling, which is a major cause of disability for older adults.
When it’s time to talk to your parent about getting help:
The Mayo Clinic advises that one of the toughest challenges in caring for the elderly is the resistance to care. How do you help a parent who doesn’t want help?

Why do my parents resist care or assistance?
An elderly parent who is in need of care is dealing with some kind of loss — the loss of independence, the loss of former physical ability, or the loss of mental acuity. Acknowledging this and accepting care means another loss — the loss of privacy. Your parent may feel vulnerable or frightened, or angry about this loss. Many older adults also feel guilt or shame at the idea of needing help or becoming a “burden” to you or others. They often see accepting help — or even asking for it — as a sign of weakness. Older adults often fret about the cost of assistance, too, even if it’s very affordable.

What’s the best way to talk to my parent about the need for care?
First, carefully choose your timing. You and your parent should not be under stress for this conversation; you should both be relaxed. Ask questions about your parent’s preferences. You can inquire about “a possible future situation” when Mom or Dad may need care. Let your parent know that you’re asking because you want to be the advocate for these future preferences.
Get family members to help. If you can’t do it, family and friends may be able to help you persuade your parent to accept help.
Don’t give up. If your first attempt doesn’t go well, try it again later.

Handling resistance to care:
The Mayo Clinic staff suggest that you bring up the idea of a trial run. Let your parent know this is not a final decision — it’s a test drive. Let Mom or Dad know that you’re the advocate, you don’t want anything that they don’t want, and you want to know what they think about this trial run.

Get help from a professional — your parent’s clergy, doctor, or attorney might offer advice that your parent is likely to listen to.

Talk about your needs, too. If some in-home care or assisted living services would make your life easier, say so. No parent wants to be a burden and a chore — if you’re putting increased time and expense into caring for your parent, and if in-home care or assisted living services would really help you out, then say so. Make it clear that you’re flexible and willing to compromise, and make sure your parent understands your care and concern.

Pick your battles carefully. Don’t argue with your parent about minor issues or preferences. 

Point out to your parent that care can prolong independence. Accepting a little help now may allow your parent to remain at home as along as possible.

Help your parent cope with the loss of independence. Make it clear that this is not a personal failing — it happens to all of us. Help your parent stay active, maintain relationships and activities, and even find new interests.